Talking leadership: insights from our work with Cambridge University Hospitals NHS Foundation Trust

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The King’s Fund is working with Cambridge University Hospitals NHS Foundation Trust (CUH) on a leadership development programme, helping the trust to develop its culture and support its leaders to deliver a long-term improvement strategy.

In this article, we talk to Joan Milne, Associate Director of Leadership and Organisational Development at CUH, and David Naylor, programme director and Senior Consultant in the Leadership and Organisational Development team at The King’s Fund, about their experience of commissioning and running the programme.

Why was change needed?

CUH provides general, specialist, women's and maternity care at Addenbrooke's Hospital and the Rosie Hospital. The trust is a university teaching hospital with a worldwide reputation, and also a leading national centre for specialist treatment; a government-designated comprehensive biomedical research centre; and one of the five academic health science centres in the UK.

The trust has faced a number of challenges in recent years. In September 2015, it was rated ‘inadequate’ by the Care Quality Commission (CQC) and placed in special measures. Joan recalls the tough times: ‘Being rated inadequate got to everyone; it had an impact on morale and confidence and really rocked us.

The trust put in place a robust quality improvement programme and, in January 2017, was taken out of special measures and rated ‘good’ by the CQC. The focus then moved to a long-term organisational strategy with a major culture change programme – CUH Together –  underpinning the strategy and aligning the trust’s vision, values, strategy, ways of working and focus on continuous improvement. CUH appointed The King’s Fund and Cambridge Judge Business School to deliver a leadership programme to support the delivery of this ambitious vision and strategy.

Commitment and expertise

Joan Milne explains what informed the development of CUH Together: ‘We talked to staff, partners and patients about what it’s like to make changes in the organisation. That gave us a clear idea of what it was like to work and be a leader here. The next step was to ask: “If things were better in the future, what would that look like?”. Building on our values, CUH Together is the result of those conversations and sets out new ways of working: choose to improve; make good and timely decisions; be trusted and accountable; pull together as a team; and be open and learn from our mistakes.’

For Joan, commitment from the board helped the leadership programme to have traction. ‘This was a planned approach to leadership development, which was vital to support our strategy,’ Joan explains. ‘Having the evidence of what we needed to change meant that we were pushing on an open door for investment and support from the board.’

Helping smart people to learn

The leadership development programme is aimed at the trust’s 150 most senior leaders and includes operational staff, clinicians and corporate staff learning in small groups to foster trust and build relationships. For David Naylor, one challenge stands out: ‘The trust faces the issue of how to enable smart people to learn. Based on the work of Chris Argyris, the theory is that it can be harder for highly skilled professionals to face what they don’t know how to do. The risk of that is that they frame challenges in terms that they feel they can resolve or deal with. And that can sometimes make it hard for people to say, “these fixes aren’t working, there’s a gap between our intention – to deliver safe, effective, high-quality and cost-effective care – and what’s actually happening in practice”.’

For David, the programme was only going to be a success if the team from the Fund worked together with CUH to understand how they could explore and close that gap. That meant participants bringing lived experience of being a leader at CUH. ‘It’s in the combination of us bringing our policy knowledge and leadership development expertise, and participants bringing their lived experience, that makes it work.’

Time to reflect

The Fund also stressed the importance of slowing down to learn. ‘These leaders are doing long hours and are under enormous pressure and sometimes those underlying gaps between what people want to do and what’s happening in practice are covered over by people by working really, really hard,’ says David. But it was important to disrupt that drive to work flat out: ‘We know that one of the ways people avoid learning is by working at pace, so our job was to slow people down; the participants understood that and came to value it.’

For Joan, asking leaders to slow down was hard but a fundamental part of the programme: ‘Slowing down can be a shock in a busy acute trust, where you go from one incident to the next. We needed our leaders to have the space to learn about themselves, and those around them, and focus on improvement,’ says Joan. ‘The King’s Fund really understood that – they saw where we were and where we wanted to be and understood how to help us get there.’